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					                MO HealthNet
           E Tools Chronic Care and P4P

           Medicaid Purchasing Leadership Summit
                           March 27-28, 2008

                George L. Oestreich, Pharm.D., MPA
                  Deputy Division Director, Clinical Services
                          MO HealthNet Division




4/7/2008                        MO HealthNet Division           1
 Elements of Healthcare Home
     Access and Communication
     Patient Tracking and Registry Functions
     Care Management
     Patient Self-Management Support
     Electronic Prescribing
     Test Tracking
     Referral Tracking
     Performance Reporting and Improvement
     Advanced Electronic Communications


4/7/2008             MO HealthNet Division     2
       Mapping & Data Integration

                              Diagnosis


              Membership                             Drug


 Pharmacy
                           Integrated
    Claims
                    Data Repository
    Medical                   Hospital             Laboratory
     Claims    Office

 Reference                        ER
      Data

4/7/2008                   MO HealthNet Division                3
             Clinical Rules System

                      Clinical &                 Table-driven criteria;
                                                 easily & rapidly
                      Business                   modified
   Integrated drug,
                         Rules
   diagnostic,
   procedure &                                  Claims involved in cases
   encounter data                                        where there are
                                                         opportunities for
                                                           improvement


    Client              Rules                       Flagged
    Data               Engine                        Claims

4/7/2008                MO HealthNet Division                             4
Self-Service Model

              Evidence
               Based
             Treatment
                                  Outputs:
             Guidelines              Reports                       MD & Rx
 Clinical                        Clinical Scores
  Data           PDL           Risk Assessments
                             Treatment Suggestions
                                    Trending             Health
            PA/Utilization   Behavioral Suggestions
            Management        Therapy Alternatives       Portal      Payor
              Criteria            Cost Savings
 Claims
                               Case Management
  Data                          DM Assignment
              Analytics           PA Approval

               Rules
               Engine                                             Consumer



 4/7/2008                        MO HealthNet Division                   5
           Driving Change Through
                  Technology




4/7/2008            MO HealthNet Division   6
Provider Portal…CyberAccess




4/7/2008     MO HealthNet Division   7
Direct Care Pro
Allows Provider to Interact With State Systems

       Notification of
       Potential Intervention
       Reserve Intervention
       Perform Intervention
       Directly Bill for
       Services




 4/7/2008                MO HealthNet Division   8
Participant Portal




                                       Print Personal Medical Profile
                                       •
                                       Medical and RX Claims history
                                       •
                                       Heath Alerts
                                       Bring the profile to discuss with
                                               you’re physician



 4/7/2008      MO HealthNet Division                                  9
Targeted Clinical Information and
Personal Health Record


                                        Members may add additional
                                          Personal & Demographic
                                                    Data
                                        •Weight
                                        •Height
                                        •Blood Type
                                        •Age
                                        •Home lab values
                                        •OTC Medications




 4/7/2008       MO HealthNet Division                          10
Seamless Link to Case Management
Tool (Care Connection)




 4/7/2008      MO HealthNet Division   11
Case Manager/Provider Interface




 4/7/2008      MO HealthNet Division   12
Missouri CCIP Per-Member Per-
Month (PMPM) Expenses

                                                                            PMPM Expenses By Condition
      P e r M e m b e r P e r M o n th




                                         5000                              4108
                                                                                  3830                                        3708
                                         4000
               E x pe ns e s




                                                            2734                         2789 2673                                   2864
                                         3000   2471 2391          2633
                                                                                                     2431 2502   2317 2136

                                         2000
                                         1000
                                            0
                                                Asthma        CAD            CHF          COPD       Diabetes    GERD        Sickle Cell
                                                                                                                              Disease
      2006
      2007 (through September)




 4/7/2008                                                                 MO HealthNet Division                                             13
Missouri CCIP Asthma Pharmacy
Utilization
                                        Asthma Participants Who Received Inhaled Corticosteroids
                                                             (N = 10,455)
       % o f P o p u la t io n




                                 100%

                                 80%
                                                                                                 55%
                                 60%
                                                               46%
                                 40%

                                 20%

                                  0%
                                                                     Inhaled Cort icost eroids



                                            2006 2007 (projected based on actual results through September)


 4/7/2008                                                       MO HealthNet Division                         14
Missouri CCIP Coronary Artery
Disease (CAD) Outcomes
                                           Participants with CAD Who Received Lipid Testing
                                                              (N = 13,724)

                                    100%
            % P a r tic ip a n ts




                                    80%

                                    60%
                                                               47%                   45%
                                    40%

                                    20%

                                     0%
                                                                       Lipid Panel



                                           2006   2007 (projected based on actual results through September)


 4/7/2008                                                    MO HealthNet Division                             15
Missouri CCIP Coronary Artery
Disease (CAD) Outcomes

                                Participants with CAD Who Received Statin Medications
                                                     (N = 13,724)

                         100%
        % Participants




                         80%
                                                                                       69%
                                                      54%
                         60%

                         40%

                         20%

                          0%
                                                     One or More Prescript ions f or St at ins



                                  2006   2007 (projected based on actual results through September)



 4/7/2008                                           MO HealthNet Division                             16
Missouri CCIP Congestive Heart
Failure Utilization
                                      Participants with CHF Who Received Cardiovascular Medications
                                                                (N = 5,543)

                    100%
      % P a r t ic ip a n t s




                                           75%                                                                                 84%
                       80%      71%                                                   72%
                                                                                                           69%
                                                                        58%
                       60%

                       40%

                       20%

                           0%
                                  ACE/ARB Rx                             Beta Blocker Rx                         Diuretic Rx



                                               2006 2007 (projected based on actual results through September)


 4/7/2008                                                        MO HealthNet Division                                               17
Missouri CCIP COPD Pharmacy
Utilization
                                            Participants with COPD Who Received Bronchodilator Medications
                                                                      (N = 1,677)

                               100%
            % P a r t ic ip a n t s




                                      80%
                                                                                               57%
                                      60%
                                                                   43%
                                      40%

                                      20%

                                      0%
                                                                           Bronchodilator Rx



                                                  2006 2007 (projected based on actual results through September)


 4/7/2008                                                          MO HealthNet Division                            18
Missouri CCIP Diabetes Outcomes

                                                Participants with Diabetes Who Received Screening Examinations
                                                                           (N = 16,076)

                           100%
            % P a r t ic ip a n t s




                              80%
                                       68%
                                                     57%
                              60%
                                                                        47%       45%
                                                                                                 31%       37%
                              40%
                                                                                                                             19%      18%
                              20%

                                  0%
                                             HbA1c                       Lipid Panel                Eye Exam                 Microalbumin



                                                           2006 2007 (projected based on actual results through September)


 4/7/2008                                                                MO HealthNet Division                                              19
Missouri CCIP GERD Utilization
Measurements
                                               ER & Hospitalization Rates for GERD Participants
                                                                  (N = 7,819)

                    25
                               21
       P a r t ic ip a n t s




                    20
                                                           16
                     15
                                                                                               12
                                                                                                                          9
                     10

                        5

                        0
                               ER Visits per 1,000 Participants                            Hospitalizations per 1,000 Participants



                                           2006 2007 (projected based on actual results through September)


 4/7/2008                                                         MO HealthNet Division                                              20
   Pay for Performance Metrics
      All Participants (Excluding GERD)
           Providing Influenza Immunization
           Providing Pneumococcal Immunization
      Asthma and COPD (20%)
           Use of Inhaled Corticosteroids
      Cardiovascular Disease (38%)
           Use of ARB or ACEI in CHF
           Use of Beta blockers in CHS
           Managing Hyperlipidemia
                Lipid profile
                Statins if indicated
      Gastroespohogeal Reflux (8%)
           Attempt to Step-down H2A or PPI Therapy
      Diabetes (34%)
           Hemoglobin A1c Monitoring
           Controlling Hyperglycemia
           Performance of Dilated Retinal Exams (DRE)
           Performing Urinary Micro albumin Tests




4/7/2008                                 MO HealthNet Division   21
Discussion

       Questions?




            George.L.Oestreich@dss.mo.gov
            573.751.6961


 4/7/2008                  MO HealthNet Division   22

				
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